Studies have shown that women-centered care improves outcomes. Women-centered care should mean that the care is focused on the women and offers consistent quality health-care while being respectful of each woman's unique needs and background. For me personally, women-centered care means that each woman gets to choose where she gives birth, who gets to be there, and that she receives respectful and quality care from her providers.
In the United States, we may claim that we offer "women-centered care," when in fact the care most consistently delivered is sub-par with less than stellar outcomes. How can this be, you may wonder, when we are a developed country with the most up-to-date medical technology money can buy? To demonstrate, I will simply point to the statistics gathered from the United Nations showing that between 1990 and 2008 the vast majority of countries reduced their maternal mortality rates for a global decrease of 34 % while maternal mortality nearly doubled in the United States (Maternal Mortality in the United States: A Human Rights Failure, Association of Reproductive Health Professionals Journal, 2011). Of the many reasons for this statistic, I would like to focus on the one that I see most often in hospitals today: the overuse of medical technology.
Studies between 1996 and 2008 show that there has been a 56% increase in surgical births, with no evidence for improved outcomes. In fact, there have been studies showing data that the increase in medical intervention actually increases maternal and infant morbidity. This is not to say that there haven't been losses due to the lack of medical technology; there have been. It's just that there are far fewer of those deaths than there are preventable deaths due to in part to the overuse of medical technology than otherwise. For example, there are countries with less life-saving medical equipment that have lost fewer mothers and babies than we do in the United States. And the reality is that the United States ranks 50th in the world in terms of maternal mortality. So while we like to think that we are safe and protected in our hospitals surrounded by the best technology on the planet; we may in fact be placing ourselves in far greater danger than we realize.
I don't mean to sound all gloom and doom, but I do think that an increase in awareness is called for. The statistics are scary, yes, so rather than argue, let's do something about it! Some states have already put in place systems to increase reporting so that we can find out more about why these deaths are on the rise and what we can do about them. There are even a few health care models utilizing fewer medical interventions and their outcomes have been consistently good. We are making progress, but it is slow. And here is where I will venture into the philosophical realm. To quote a Native American saying used most often by environmentalists, "tread lightly upon the Earth, and live in balance and harmony."
In order to improve our obstetric care in the United States we have to start treading lightly. Birth is not something that responds to a hammer fist of intervention. Truly, birth works best when it is left alone. In this instance an encouraging word and a gentle touch will do far more to effect good outcomes than a mighty weapon (forceps, episiotomy) and a take charge attitude. I've seen too many doctors enter a delivery room and take over the whole scene. I am here now, and since I am here, I must now do something to get this baby out! Seriously?!
Again, just to qualify, I do not mean that birth always works best when left alone. Of course, there are times when medical intervention is called for and necessary. But when there is no true medical need and intervention is still applied, for whatever reason, that is what I am railing against. That is where we run into trouble. So when a doctor says it doesn't matter how the baby is born, you have my permission to say, "Actually it does and you are not following evidence-based practices if you believe otherwise." Medical procedures should be left for when they are truly medically necessary. Women should be assured that medical professionals have their best interests at heart. They should be assured that nothing will be done that might endanger their lives or the lives of their babies.
The really backwards thinking that goes on is that by doing more medical interventions, we think we are preventing complications and death, but that is just not true based on the statistics. So, to improve care, we need to start paying attention to the data. It does not pay to induce labor unnecessarily. It does not pay to do routine cesareans. Most importantly, it does not pay and it can do severe harm. It's time we started paying attention to other countries where outcomes are better and try to adopt more women-centered practices here in the United States.
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